Save Money – Protect the Environment

Energy conservation is everyone’s responsibility, and we want to help you do your part. Business Lighting Rebates

encourage customers to conserve energy, which saves your business money and helps protect the environment.

We are committed to being an environmentally-friendly utility.

Business Lighting Equipment Rebates

In addition to rebates for T-12 to T-8 lamps and ballasts, we’ve added rebates this year for retrofitting

Metal Halide (MH) equipment to more efficient technology–see details inside.

Rebates are offered on a first-come, first-served basis and are subject to eligibility and availability of funds.

Certain other conditions and restrictions apply. To verify availability of rebate funds, call 448-4800. For more

information, call 448-4800 or visit www.csu.org.

Save Energy and Improve Your Bottom Line

Log on to http://www.csu.org/ to learn about saving more with energy-efficient products in your business. Our online

Energy Efficiency Profile is your comprehensive source for reliable information about your energy use

and changes you can make to save time and energy.

Colorado Springs Utilities is committed to energy conservation as an ongoing practice.

We believe it is important to have proactive programs to ensure efficient use of

natural resources as part of our community and environmental responsibility.

0508 5907 CENV

• Equipment must be installed in the Colorado

Springs Utilities electric service area.

• Equipment purchase(s) must be made from

Jan. 1, 2008 to Dec. 31, 2008.

• Fixtures, parabolic reflectors, disposal costs and

installation costs are not rebated.

• Rebate application(s) must be complete and

include the equipment worksheet and a copy

of the purchase receipt(s). Incomplete

applications, worksheets and/or those lacking a

copy of the purchase receipt(s) will be denied.

• Purchase receipt(s) must clearly identify the

approved equipment included on the equipment

worksheet and include date of purchase,

purchase price and quantity purchased.

• Lighting equipment retrofit must be completed

within the current year and prior to rebate

application submittal.

• Participant must be a Colorado Springs Utilities

business electric customer and account must be

in applicant’s name.

• Participant’s Colorado Springs Utilities

account(s) must be current (i.e. no past-due

balances) at the time the incentive application

is processed.

• Rebate application(s) must be postmarked by

Dec. 31, 2008.

• Rebates are offered on a first-come, first-served

basis and are subject to eligiblility and availability of

funds. Customers are encouraged to call 448-4800 and verify availability of funds prior to purchasing

lighting equipment.

• Lamps and ballasts rebated under this program

are not eligible for additional rebates under any

other Colorado Springs Utilities incentive

program.

• Installation site is subject to inspection by

Colorado Springs Utilities staff, and if such site

does not have the qualifying equipment installed,

the amount rebated will be charged back to the

electric account.

• This program is for retrofit applications only, and

does not apply to new construction.

• For safety purposes, all lamps and ballasts used

for retrofit must be UL listed. Springs Utilities

reserves the right to remove any non-complying

participant from the program and the amount

rebated will be charged back to the electric

account. For more information see: www.ul.com

• All participants in the Business Lighting Rebate

Program are individually and solely responsible

for compliance with federal, state and local

guidelines, and requirements for proper lamp and

ballast management including, but not limited to,

storage, transportation, recycling and disposal.

The provision of a rebate under this program

does not constitute an endorsement by Colorado

Springs Utilities that the rebate participant is in

compliance with waste management guidelines

or requirements, and Colorado Springs Utilities

is under no obligation to independently

monitor such compliance. If a federal or state

regulatory agency makes a final determination

that the participant has not complied with waste

management requirements, Colorado Springs

Utilities reserves the right to remove the noncomplying

participant from the program, and

the amount rebated will be charged back to the

electric account.

• Ballasts manufactured prior to Jan. 1, 1979 must

be assumed to contain Poly Chlorinated Biphenals

(PCB’s) requiring proper management. Sources

of information include: www.epa.gov/opptintr/pcb/laws.html and www.cdphe.state.co.us/hm/UWRgeneral.pdf.

• All T-12 fluorescent lamps contain mercury and

fall under state and federal requirements regarding

the management of hazardous waste and universal

waste. Sources of information include: www.epa.gov/epaoswer/hazwaste/id/univwast.htm and

• Colorado Recycles is one source of information

regarding recyclers and can be found at: www.colorado-recycles.org. (This is provided for

informational purposes only and does not

constitute an endorsement by Springs Utilities of

validity or completeness of the list of recyclers nor

of the compliance status of the recyclers contained

on the list).

0508 5907 CENV

Business Name:

Installation Address: Zip:

E-mail Address:

Contact Person: Phone: Fax:

Professional contractor. Labor cost: $ (Note: Labor costs do not qualify for rebate)

or

Self. I certify that the rebated lighting equipment was (or will be) self-installed:

(Applicant’s Signature)

( hours per day X days per month X 12 months) =

0508 5907 CENV

Grocery

Health Care

Lodging

Manufacturing/Industry

Multi-family

Office

Restaurant

Retail

School/University

Warehouse

Other:

Colorado Springs Utilities Web site (www.csu.org)

Co-worker, friend

Bill insert/newsletter

Colorado Springs Utilities employee

Business association

Business publication

Direct mailing

Media (newspaper, radio, TV, etc.)

Other:

0508 5907 CENV 4

250 Watt Standard Metal Halide (MH) retrofitted to:

200 Watt (or below) MH Pulse-start & electronic ballast $30 X__________= $________

250 Watt Standard Metal Halide (MH) retrofitted to:

5-Lamp or less fluorescent HPT8 $40 X__________= $________

400 Watt Standard Metal Halide (MH) retrofitted to:

320 Watt (or below) MH Pulse-start & electronic ballast $60 X__________= $________

400 Watt Standard Metal Halide (MH) retrofitted to:

6-Lamp or less fluorescent T5HO $60 X__________= $________

400 Watt Standard Metal Halide (MH) retrofitted to:

8-Lamp or less fluorescent HPT8 $75 X__________= $________

400 Watt Standard Metal Halide (MH) retrofitted to:

5-Lamp or less 5-Lamp x fluorescent T5HO $75 X__________= $________

1,000 Watt Standard Metal Halide (MH) retrofitted to:

18-Lamp or less fluorescent HPT8 $125 X__________= $________

1,000 Watt Standard Metal Halide (MH) retrofitted to:

14-Lamp or less fluorescent T5HO $125 X__________= $________

Retrofitted to: $ X__________= $________

If you don’t see your lighting scenario call us,

we’ll consider it and get back to you. TOTAL REBATE= $________

Is the equipment you installed

UL-listed?

Have you read and understood the

Waste Management requirements listed

on page 2 of this form?

Have you filled out the application

completely?

Did you include a copy of

the receipt(s)?

Have you filled out the equipment

worksheet completely?

Have you attached a copy of acceptable

identification to comply with House Bill

06S-1023?

• Review program rules on page 2 of

this form.

• Call 448-4800 and verify availability

of funds prior to purchasing lighting

equipment.

• Purchase and install the qualifying

equipment. (See program rules and

eligibility requirements listed on page

2 of this form for qualifications).

• Complete the application form.

• Purchase receipts must include date of

purchase, purchase prices and

quantity purchased.

• Return completed application form/

equipment worksheet and a copy of

legible purchase receipts to Colorado

Springs Utilities at the following address:

The Business Lighting Rebate Program

remittance will take six to eight weeks

to process.

5 0508 5907 CENV

Colorado Springs Utilities Account #:

Business Name:

Service Address: Zip:

Mailing Address: Zip:

Phone:

E-mail Address:

Colorado Springs Utilities makes no representations or warranties about any

make or model of equipment, including any warranties of merchantability,

fitness for a particular purpose or energy efficiency. This rebate program

is subject to change and/or discontinuation without notice. Colorado

Springs Utilities reserves the right to inspect installation premises or request

additional information/documentation prior to rebate payment. Colorado

Springs Utilities is not liable or responsible for any act or omission of any

contractor whatsoever.

In no event shall Colorado Springs Utilities be liable to rebate participant or

any third party for any special, incidental, indirect or consequential damages,

including loss of profits, loss of use or cost of replacement equipment

associated with retrofit of lighting and management of resultant wastes.

Nothing in the Business Lighting Efficiency Rebate Program shall be

interpreted to limit or prevent the protections afforded to Springs Utilities

under the Colorado Governmental Immunity Act, C.R.S. § 24-10-101, et seq.

I would like to donate all or a portion of my rebate to Project

COPE. Your contribution may qualify as a charitable contribution

for income tax purposes. Consult your tax advisor for further

information. One hundred percent of donations go to families in

need to help pay their utility bills.

Specify Amount:

I have read and understand the requirements as stated in the

Program Rules on page 2 of this form.

Applicant’s Signature:

Applicant’s Name (print):

Date:

This form is required for all residential applicants and sole proprietors

in compliance with Colorado House Bill 065-1023.

I, (print name legibly), swear or affirm under penalty of

perjury under the laws of the State of Colorado that (check one):

I am a United States citizen; or

I am not a United States citizen, but I am a Permanent Resident of the United States; or

I am not a United States citizen, but I am lawfully present in the United States pursuant to Federal law.

I understand that this sworn statement is required by law because I have applied for a public benefit. I understand

that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this

public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation

in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under

Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is

fraudulently received.

Applicant’s Signature Date

I, (printed name), an employee of Colorado Springs Utilities,

verified the above named applicant’s proof of lawful presence in the United States in accordance with Colorado law. The

applicant provided the following evidence of lawful presence in the United States:

Colorado Driver’s License Colorado Identification Card

U.S. Military Identification Card U.S. Military Dependent Identification Card

U.S. Coast Guard Merchant Mariner Card Native American Tribal Document

I.D. Number: I.D. Expiration Date:

Colorado Springs Utilities Employee Signature Date

If the above named applicant’s lawful presence is required by law to be verified through the SAVE Program, such verification

was attempted on ________________ by ________________________. Verification was finalized on ____________________

by ________________________________.

0508 5907 CENV 6